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Medical Schemes – Compare Medical Schemes in South Africa


Some Points to Check When You Compare Medical Schemes

There are currently around 90 medical schemes operating in South Africa, so it would not be an easy task to compare them all. In practice, however, there is no need to go to such lengths. They can be divided in to two types, known as open and closed. In the latter case, membership is not open to everyone but is restricted to those who belong to a particular group. The group could be the employees of a specific company such as Anglo American, an industry such as mining, or the members of a professional body such as the Institute of Chartered Accountants.

Because they are designed to serve the needs of a particular group, and thus have a captive client base, the premium rates for closed schemes are usually discounted, while membership is often a condition of employment. The open option is designed for those who do not qualify for a group membership, such as the self-employed individual. Because, in this case, both the premiums and the benefits vary quite widely, it is important to compare open medical schemes carefully before signing on the dotted line.

The cost of healthcare in both public and private sectors continues to rise and to maintain affordability, fund managers needed to find ways to stabilise premium rates. In some cases, this is achieved by curtailing benefits, so this is the area on which prospective members need to focus.

Based on their personal experience, they need to identify the needs of everyone to be covered by the membership and to ensure that the product chosen meets those needs. For those with young children, orthodontics could be important, while for couples planning a family, adequate cover for maternity and paediatric services will be crucial. By contrast, a young single individual in good health may only need to worry about emergencies and a hospital plan could suffice.

Comparison sites are helpful but there is no substitute for experience. Fifty years have seen few that can compare with KeyHealth medical schemes.